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The NHS plans to reach net zero emissions targets by 2040, making an 80 per cent reduction by 2028-32. Currently, emissions generated by the NHS are equivalent to 4 per cent of England’s total carbon footprint.
Some 3.5 per cent (9.5 billion miles) of all road travel in England relates to patients, visitors, staff and suppliers to the NHS. Medicines account for 25 per cent of emissions within the NHS, with inhalers responsible for 3 per cent. Around 20 per cent are due to manufacturing processes and freight in the supply chain.
The number of medicines dispensed in primary care has doubled in recent years, from an average of 10 per person in 1996 to 20 per person in 2020, according to the Royal Pharmaceutical Society (RPS). The Government’s review into overprescribing estimated that at least 10 per cent of prescriptions in primary care need not have been issued, while over £300 million is wasted on unused or partly used medicines each year.
“For us as pharmacists and the wider pharmacy team, we have a leading part to play in making medicines use more sustainable,” says Elen Jones, director of RPS Wales. “As a starting point, we’d encourage pharmacy staff to seek out our Climate Change charter.”
Ms Jones explains that while awareness of climate issues is rising among the public, few are aware of the healthcare sector’s impact. “We’d encourage all pharmacy teams to explain this link to their patients and include them as equal partners in changes to their treatment to become more sustainable,” she says.
Minna Eii from Pharmacy Declares (pharmacydeclares.co.uk), a group of climate conscious pharmacy professionals, says: “We think community pharmacists are well placed to help people with making healthy interventions to improve their health, so they won’t need as many medicines or hospital appointments.”
Net zero goals and sustainability pledges
In its report Delivering a net zero NHS, NHSE sets itself the target of reaching net zero by 2040, with an 80 per cent reduction by 2028-32 for emissions the NHS can control.
There are several interventions being made to achieve these targets, including working with medicines suppliers and the electrification of the transport fleet and vehicles from commissioned services. The NHS Long Term Plan commitment is for 90 per cent of the fleet to use low, ultra-low and zero emission vehicles by 2028. Reducing emissions from use of inhalers is another focus point.
The RPS has published a climate declaration, with a policy that focuses on reducing the environmental impact of medicines. It has four policies on sustainability, including better prescribing practices, tackling waste and improved ways of working.
Key messages for patients which help make medicines more sustainable include not stockpiling medicines, only ordering repeat prescriptions when needed, bringing back unused medicines to the pharmacy and not flushing medicines down the toilet or sink, says Jones.
Insulin pen recycling service
In the UK alone, Novo Nordisk distributes 23 million pre-filled injection pens annually, resulting in 400 tonnes of plastic waste. Healthcare providers with patients who use Novo Nordisk pre-filled pens are being encouraged to support the company’s PenCycle recycling scheme, and around 3,700 pharmacies have already signed up. More than 100,000 pens have been returned so far. Pharmacies can contact Alliance Healthcare to register for the free service.
When dispensing Novo Nordisk pens, pharmacy teams can tell customers about the recycling scheme and offer them a PenCycle return box. Customers fill the box with empty pens (needles removed) and return it to the pharmacy, where they can be offered another empty box. Pharmacies store the full boxes in a PenCycle recycling bin, which is collected by Alliance Healthcare via the AH portal.
Every pen that is returned is sent back to Novo Nordisk’s facility in Denmark, where up to 85 per cent of materials are recycled.
“We were getting through five or six massive rolls of bubble wrap a week for our online business and we needed to find an alternative to plastic”
How many pharmacies are reducing their environmental impact
Landys Chemist in North London has switched from using plastic bubble wrap to sustainable perforated paper packaging for its online orders.
Mitesh Desai, head of e-commerce at the pharmacy, explains: “I felt we had a responsibility to work in a more sustainable way. We were getting through five or six massive rolls of bubble wrap a week for our online business and we needed to find an alternative to plastic. We found a consultant and got some advice on the best way to go about making changes. We began the process in 2018 and are now fully plastic-free.”
At least 95 per cent of Landys’ waste now gets recycled, and Desai says that a vitamins brand it works with “adds 25p to the price of each bottle they sell and customers get the money back if they return it”.
Alliance Healthcare’s mission is to become the most sustainable pharmaceutical wholesaler in the UK. It has pledged to achieve carbon net zero by 2030. Parent company Amerisource Bergen has committed to efficient and responsible operations across its global supply chain. “At the enterprise level, we have a fully verified science-based target to reduce absolute scope 1 and 2 greenhouse gas emissions by 54.6 per cent by 2032. Amerisource Bergen commits that 82 per cent of its suppliers by spend, covering purchased goods and services, will have science-based targets by 2027,” says a company spokesperson.
Alliance reduced its use of single use plastic by 60 per cent last year and has invested in reusable totes to replace single use plastic and cardboard by two million units a year. It is also replacing its fleet with eco friendly vehicles and reducing delivery miles via effective route reviews.
Pharmacy Declares was set up to encourage pharmacy professionals to tackle the climate crisis by reducing the impact of medicines on the environment. Co-founder Minna Eii explains: “Simple measures are effective at reducing medicines waste. Encourage customers to check their prescription bags before they leave the shop – are there any in there not for them? It’s much easier to return them immediately.”
It’s also important to educate customers about medicines pollution, says Eii, citing a recent survey which found that just 29 per cent of patients recycled unwanted medicines via their pharmacy.
She also recommends looking at fossil fuel usage in the pharmacy, such as switching to renewable energy sources and switching off neon signs and computers at night.
Pressurised metered dose inhalers (pMDIs) make up 70 per cent of inhalers prescribed in the UK and account for 3 per cent of the NHS’s carbon emissions and 13 per cent in primary care. Other EU countries use as few as 13 per cent.
The NHS is encouraging healthcare professionals to give people over age 12 the choice of changing to a lower carbon inhaler. “More than 85 per cent of people with asthma and carers support the use of more environmentally friendly inhalers,” says Emma Rubach, head of health advice at Asthma & Lung UK. “Community pharmacists can remind people that changing inhaler is always a choice that should be made together with their healthcare professional. They can assure people that changing to a lower carbon inhaler is easy for most people, and many people find them easier to use.”
The lower carbon options are dry powder inhalers (DPIs) and soft mist inhalers (SMIs). Most patients can use these and there is no need for a spacer. For patients who can’t change from a pMDI, there are other ways to reduce emissions.
“Changing to a lower carbon inhaler is only part of the picture,” says Rubach. “The first step is to make sure they’re taking their preventer inhaler every day, as prescribed, to help reduce the risk of an asthma attack that could result in having to take lots more medicine. And if they need to continue using a pMDI then using a spacer is vital to ensure more of the medicine reaches their lungs.”
Chiesi inhaler recycling service
Pharmacies are being encouraged to get patients to return inhaler devices for green disposal and recycling. Chiesi has been involved in an NHS pilot scheme called ‘Leicestershire Take AIR’. Supported by university hospitals of Leicester NHS Trust and Leicestershire & Rutland LPC, the scheme ran for 12 months last year and has been extended for a further 12 months.
It was the first to allow people to dispose of inhalers by post. Local pharmacies in the area give out Take AIR prepaid envelopes and patients can put up to four inhalers in each. More than two-thirds of all community pharmacies in the region have taken part.
“When surveying patients, pharmacists and other healthcare professionals, we found that 100 per cent of pharmacists and healthcare professionals and 99 per cent of patients believed schemes like Take AIR should be rolled out nationally,” says Chiesi’s Sarah Pollard. “Some 69 per cent of pharmacists and 100 per cent of healthcare professionals said at least 80 per cent of people they spoke to about the scheme were willing to participate.”
As of the end of February 2023, over 52,000 inhalers had been recycled and 305 tonnes of CO2 captured. In a survey by Chiesi of patients who used the service, less than 20 per cent said they had previously returned their inhalers to a pharmacy.
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